U.S. patent number 10,524,640 [Application Number 15/449,627] was granted by the patent office on 2020-01-07 for endoscopic treatment instrument, treatment instrument unit, and treatment system.
This patent grant is currently assigned to OLYMPUS CORPORATION. The grantee listed for this patent is OLYMPUS CORPORATION. Invention is credited to Hiroyuki Araki, Ken Fujisaki, Kazuhiro Yoshida.
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United States Patent |
10,524,640 |
Fujisaki , et al. |
January 7, 2020 |
Endoscopic treatment instrument, treatment instrument unit, and
treatment system
Abstract
An endoscopic treatment instrument includes a guide sheath. The
guide sheath includes a second distal end, which has an inside
diameter to insert the insertion portion therethrough so that the
distal end of the insertion portion is configured to protrude
relative to the second distal end. The guide sheath is inserted
through the guide pipe so that the second distal end is configured
to protrude relative to the first distal end of the guide pipe.
Inventors: |
Fujisaki; Ken (Sagamihara,
JP), Araki; Hiroyuki (Hachioji, JP),
Yoshida; Kazuhiro (Sagamihara, JP) |
Applicant: |
Name |
City |
State |
Country |
Type |
OLYMPUS CORPORATION |
Hachioji-shi, Tokyo |
N/A |
JP |
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|
Assignee: |
OLYMPUS CORPORATION (Tokyo,
JP)
|
Family
ID: |
55439577 |
Appl.
No.: |
15/449,627 |
Filed: |
March 3, 2017 |
Prior Publication Data
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Document
Identifier |
Publication Date |
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US 20170172389 A1 |
Jun 22, 2017 |
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Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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PCT/JP2015/072534 |
Aug 7, 2015 |
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Foreign Application Priority Data
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Sep 5, 2014 [JP] |
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2014-181739 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
1/00154 (20130101); A61B 1/05 (20130101); A61B
1/00142 (20130101); A61B 1/00082 (20130101); A61B
1/00172 (20130101); A61B 1/0016 (20130101); A61B
1/07 (20130101); A61B 1/233 (20130101); A61B
17/24 (20130101); A61B 1/00163 (20130101); A61M
1/0064 (20130101); A61B 1/015 (20130101); A61B
1/00094 (20130101); A61B 17/3421 (20130101); A61B
2017/0046 (20130101); A61B 2017/22051 (20130101); A61B
2017/0038 (20130101); A61M 2210/0681 (20130101); A61B
2217/005 (20130101); A61B 2017/00367 (20130101); A61B
2017/246 (20130101); A61B 2090/0811 (20160201); A61B
2017/00455 (20130101); A61B 2017/00991 (20130101); A61B
2090/306 (20160201); A61B 2090/3614 (20160201); A61B
2090/036 (20160201); A61B 2017/00331 (20130101); A61B
2017/00477 (20130101); A61B 90/36 (20160201) |
Current International
Class: |
A61B
1/00 (20060101); A61B 1/015 (20060101); A61B
1/05 (20060101); A61B 17/24 (20060101); A61B
1/07 (20060101); A61B 1/233 (20060101) |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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202006017173 |
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Feb 2007 |
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DE |
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102011107614 |
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Jan 2013 |
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DE |
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2005532869 |
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Nov 2005 |
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JP |
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2010515529 |
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May 2010 |
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JP |
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2013540502 |
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Nov 2013 |
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JP |
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2008124482 |
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Oct 2008 |
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WO |
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2013-119258 |
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Aug 2013 |
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WO |
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2014/072977 |
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May 2014 |
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WO |
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Other References
Apr. 17, 2018 extended Search Report issued in European Patent
Application No. 15838306.7. cited by applicant .
Mar. 7, 2017 International Preliminary Report on Patentability
issued in International Patent Application No. PCT/JP2015/072534.
cited by applicant .
Nov. 2, 2015 International Search Report issued in International
Patent Application No. PCT/JP2015/072534. cited by applicant .
May 7, 2019 Office Action issued in Japanese Application No.
2017-007631. cited by applicant .
Jun. 5, 2019 Office Action issued in Chinese Application No.
201580047576.6. cited by applicant .
Nov. 5, 2019 Office Action issued in Japanese Patent Application
No. 2017-007631. cited by applicant.
|
Primary Examiner: Neal; Timothy J
Attorney, Agent or Firm: Oliff PLC
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a Continuation Application of PCT Application
No. PCT/JP2015/072534, filed Aug. 7, 2015 and based upon and
claiming the benefit of priority from prior Japanese Patent
Application No. 2014-181739, filed Sep. 5, 2014, the entire
contents of all of which are incorporated herein by reference.
Claims
What is claimed is:
1. An endoscopic treatment instrument configured to be used with an
endoscope including an insertion portion that includes an
observation optical system, the endoscopic treatment instrument
comprising: a guide pipe that has a first distal end and is
configured to receive the insertion portion therethrough so that an
area in front of a distal end of the insertion portion and an area
in front of the first distal end of the guide pipe are observable
through the first distal end by the observation optical system or
so that the area in front of the distal end of the insertion
portion is observable by the observation optical system while the
distal end of the insertion portion is protruded relative to the
first distal end; and a guide sheath including: a second distal
end, an inside diameter configured to receive the insertion portion
therethrough so that the distal end of the insertion portion can
protrude relative to the second distal end, the guide sheath being
inserted through the guide pipe so that the second distal end of
the guide sheath can protrude relative to the first distal end of
the guide pipe, and a crooked portion having a pre-formed bend
positioned at a distance from the second distal end of the guide
sheath in a proximal direction, the crooked portion of the guide
sheath being configured to be more rigid than a pre-formed crooked
portion of the insertion portion.
2. The treatment instrument according to claim 1, wherein the guide
sheath is turnable relative to the guide pipe such that the second
distal end draws a circular-ring orbit in response to turning of
the guide sheath.
3. The treatment instrument according to claim 1, further
comprising a handle unit that is configured to be grasped by a
user, and includes a first operation element that is configured to
move the guide sheath in an axial direction relative to the guide
pipe and the insertion portion, and is turnable around its
axis.
4. The treatment instrument according to claim 3, wherein the
handle unit has an index which allows the user to recognize: an
axial position of the second distal end of the guide sheath
relative to the first distal end of the guide pipe, and a
circumferential position of the second distal end of the guide
sheath relative to the first distal end of the guide pipe.
5. The treatment instrument according to claim 3, wherein the
handle unit further includes a second operation element that is
configured to move the insertion portion in the axial direction
relative to the guide pipe and the guide sheath, and is turnable
around its axis.
6. The treatment instrument according to claim 5, wherein the
handle unit has an index which allows the user to recognize: an
axial position of the distal end of the insertion portion relative
to the first distal end of the guide pipe, and a circumferential
position of the distal end of the insertion portion relative to the
first distal end of the guide pipe.
7. The treatment instrument according to claim 1, further
comprising a handle unit which is configured to be grasped by a
user and includes: a first operation element configured to move the
guide sheath relative to the guide pipe and the insertion portion;
and a second operation element which is operable to move the
insertion portion relative to the guide pipe and the guide sheath,
and which is operable together with the first operation
element.
8. The treatment instrument according to claim 1, wherein the guide
pipe includes: a bent pipe portion having the first distal end at
its distal end portion, and a straight pipe portion provided at a
proximal end of the bent pipe, at least part of the straight pipe
portion being elastically deformable.
9. A treatment instrument unit comprising: an endoscope including
an insertion portion having flexibility and an observation optical
system; and the treatment instrument according to claim 1 through
which the insertion portion is inserted relative to the guide pipe
and the guide sheath.
10. The treatment instrument unit according to claim 9, wherein:
the insertion portion includes: a distal hard portion formed at its
distal end, and a flexible pipe portion formed on a proximal side
of the distal hard portion, and the guide pipe includes: a straight
pipe portion through which the guide sheath is movable while the
insertion portion is inserted through the guide sheath, and a bent
pipe portion which is located on a distal side of the straight pipe
and which has an inside diameter and a bending radius that permit
the distal hard portion of the insertion portion to protrude on the
distal side through the first distal end while the insertion
portion is inserted through the guide sheath.
11. The treatment instrument unit according to claim 9, wherein the
insertion portion has a first crooked portion having a pre-formed
bend positioned at a first distance from its distal end in the
proximal direction.
12. The treatment instrument unit according to claim 11, further
comprising a handle unit which includes: a first operation element
which is configured to move the guide sheath in an axial direction
relative to the guide pipe and the insertion portion, and which is
turnable around its axis, a second operation element which is
configured to move the insertion portion in the axial direction
relative to the guide pipe and the guide sheath, and which is
turnable around its axis, and a first index which allows a user to
recognize: an axial position of the distal end of the insertion
portion relative to the first distal end of the guide pipe, and a
circumferential position of the distal end of the insertion portion
relative to the first distal end of the guide pipe.
13. The treatment instrument unit according to claim 12, wherein:
the handle unit includes a second index which allows the user to
recognize: an axial position of the second distal end of the guide
sheath relative to the first distal end of the guide pipe, and a
circumferential position of the second distal end relative to the
first distal end of the guide pipe, and the crooked portion of the
guide sheath is bent in an identical direction to that of the first
crooked portion of the insertion portion when the first index and
the second index are located at the same circumferential
position.
14. The treatment instrument unit according to claim 12, wherein
the first distal end of the guide pipe is aligned with the distal
end of the insertion portion of the endoscope when the first index
is located at a predetermined position relative to the handle
unit.
15. The treatment instrument unit according to claim 9, wherein the
insertion portion includes a first crooked portion having a
pre-formed bend positioned at a first distance from its distal end
in the proximal direction.
16. The treatment instrument unit according to claim 15, further
comprising a handle unit which includes: a first operation element
which is configured to move the guide sheath in an axial direction
relative to the guide pipe and the insertion portion, and which is
turnable around its axis, a first index which allows a user to
recognize: an axial position of the second distal end of the guide
sheath relative to the first distal end of the guide pipe, and a
circumferential position of the second distal end relative to the
first distal end of the guide pipe, and a second operation element
which is configured to move the insertion portion in the axial
direction relative to the guide pipe and the guide sheath and which
is turnable around its axis.
17. The treatment instrument unit according to claim 16, wherein:
the handle unit further includes a second index which allows the
user to recognize: an axial position of the distal end of the
insertion portion relative to the first distal end of the guide
pipe, and a circumferential position of the distal end of the
insertion portion relative to the first distal end of the guide
pipe, and the crooked portion of the guide sheath is bent in an
identical direction to that of the first crooked portion of the
insertion portion when the first index and the second index are
located at the same circumferential position.
18. The treatment instrument unit according to claim 17, wherein
the distal end of the insertion portion of the endoscope is aligned
with the second distal end of the guide sheath when each of the
first index and the second index is located at a predetermined
axial position relative to the handle unit.
19. The treatment instrument unit according to claim 15, wherein
the distance between the crooked portion of the guide sheath and
the second distal end of the guide sheath is equal to the first
distance between the first crooked portion of the insertion portion
and the distal end of the insertion portion.
20. The treatment instrument unit according to claim 9, wherein the
guide pipe includes: a bent pipe portion, and a straight pipe
portion which is: (i) provided at a proximal end of the bent pipe
portion, (ii) at least partly elastically deformable, and (iii)
more rigid than the insertion portion of the endoscope and the
guide sheath.
21. A treatment system comprising: the treatment instrument unit
according to claim 9; and a controller which is connected to the
endoscope of the treatment instrument unit and is configured to
control the observation optical system.
22. The treatment instrument unit according to claim 9, further
comprising a handle unit which is configured to be grasped by a
user and includes: a first operation element which is configured to
move the guide sheath relative to the guide pipe and the insertion
portion; and a second operation element which is operable to move
the insertion portion relative to the guide pipe and the guide
sheath, and which is operable together with the first operation
element.
23. The treatment instrument according to claim 1, wherein the
pre-formed bend of the crooked portion of the guide sheath is an
angular bend.
24. The treatment instrument according to claim 1, wherein the
guide sheath is configured to be changed between: an interlocked
state in which the guide sheath is configured to move together with
the insertion portion relative to the guide pipe, and a
non-interlocked state in which the guide sheath is moveable
independently of the insertion portion relative to the guide pipe.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to an endoscopic treatment instrument used
together with an endoscope, a treatment instrument unit having the
treatment instrument, and a treatment system.
2. Description of the Related Art
For example, U.S. Pat. No. 7,559,925 has disclosed a treatment
instrument in which a light guide fiber is inserted through a guide
pipe. This treatment instrument guides the light guide fiber to a
paranasal sinus while visually recognizing, through the skin and
bone of a patient, light emitted from the distal end of the light
guide fiber. That is, the position of the distal end of the light
guide fiber in the nasal cavity is estimated on the basis of the
light emitted from the distal end of the light guide fiber.
BRIEF SUMMARY OF THE INVENTION
According to an aspect of the invention, there is provided an
endoscopic treatment instrument used together with an endoscope
including an insertion portion through which an observation optical
system is inserted, the endoscopic treatment instrument including:
a guide pipe which has a first distal end and through which the
insertion portion is inserted so that a distal side of a distal end
of the insertion portion and a distal side of the first distal end
are observable through the first distal end by the observation
optical system or so that the distal side of the distal end of the
insertion portion is observable by the observation optical system
while the distal end of the insertion portion is protruded relative
to the first distal end; and a guide sheath which has a second
distal end and which has an inside diameter to insert the insertion
portion therethrough so that the distal end of the insertion
portion is configured to protrude relative to the second distal end
and which is inserted through the guide pipe so that the second
distal end is configured to protrude relative to the first distal
end of the guide pipe.
Advantages of the invention will be set forth in the description
which follows, and in part will be obvious from the description, or
may be learned by practice of the invention. Advantages of the
invention may be realized and obtained by means of the
instrumentalities and combinations particularly pointed out
hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
The accompanying drawings, which are incorporated in and constitute
a part of the specification, illustrate embodiments of the
invention, and together with the general description given above
and the detailed description of the embodiments given below, serve
to explain the principles of the invention.
FIG. 1A is a schematic diagram of a treatment system according to a
first embodiment;
FIG. 1B is a schematic front view showing an endoscopic treatment
instrument unit of the treatment system viewed from the direction
of an arrow 1B in FIG. 1A;
FIG. 2A is a schematic top view showing the endoscopic treatment
instrument unit of the treatment system viewed from the direction
of an arrow 2A in FIG. 1A;
FIG. 2B is a schematic longitudinal sectional view of the
endoscopic treatment instrument unit along the arrow 2B-2B line in
FIG. 2A;
FIG. 3 is a schematic longitudinal sectional view showing the
distal end of an insertion portion of an endoscope of the treatment
instrument unit of the treatment system according to the first
embodiment;
FIG. 4A is a schematic diagram showing a scanning path which is
scanned with illumination light actuated by an actuator and emitted
from an illumination optical fiber from a position indicated by a
reference sign C to a position indicated by a reference sign YMAX
when a subject is observed by an observation optical system of the
insertion portion of the endoscope of the endoscopic treatment
instrument unit according to the first embodiment;
FIG. 4B is a schematic diagram showing a scanning path which is
scanned with the illumination light emitted from the illumination
optical fiber from the position indicated by the reference sign
YMAX to the position indicated by the reference sign C;
FIG. 5A is a schematic cross sectional view of the endoscopic
treatment instrument unit along the arrow 5A-5A line in FIG.
2B;
FIG. 5B is a schematic cross sectional view of the endoscopic
treatment instrument unit along the arrow 5B-5B line in FIG.
2B;
FIG. 6A is a schematic diagram showing, in an enlarged form, the
endoscopic treatment instrument unit at a position indicated by the
reference sign 6A in FIG. 2B in the vicinity of a connection
pipe;
FIG. 6B is a schematic diagram showing, in an enlarged form, the
endoscopic treatment instrument unit at a position indicated by the
reference sign 6B in FIG. 2B in the vicinity of a first operation
element;
FIG. 7 is a schematic longitudinal sectional view showing a guide
sheath of the treatment instrument unit according to the first
embodiment;
FIG. 8A is a schematic longitudinal sectional view showing a guide
pipe of the treatment instrument unit of the treatment system
according to the first embodiment;
FIG. 8B is a schematic enlarged view showing an elastic portion of
a straight pipe of the guide pipe indicated by the reference sign
8B in FIG. 8A;
FIG. 8C is a schematic enlarged view showing the distal end of a
bent pipe of the guide pipe indicated by the reference sign 8C in
FIG. 8A;
FIG. 8D is a schematic enlarged view showing the distal end of the
bent pipe of the guide pipe indicated by the reference sign 8C in
FIG. 8A in a modification of FIG. 8C;
FIG. 8E is a schematic longitudinal sectional view showing a
modification of the guide pipe shown in FIG. 8A;
FIG. 9 is a schematic top view showing how indexes are formed in a
handle unit of the endoscopic treatment instrument unit of the
treatment system from the direction of an arrow 2A in FIG. 1A;
FIG. 10 is a schematic diagram showing an example of an interlock
mechanism which is disposed in the handle unit of the treatment
instrument unit of the treatment system according to the first
embodiment and which switches to an interlocked state to interlock
the operations of the first operation element and a second
operation element and to a non-interlocked state for independent
operations;
FIG. 11 is a schematic longitudinal sectional view of the
endoscopic treatment instrument unit showing how the distal end of
an insertion portion of the endoscope including a crooked portion
is protruded relative to the distal end of the guide pipe of the
treatment instrument unit of the treatment system according to the
first embodiment, and the distal end of the insertion portion of
the endoscope including the crooked portion is turnable on the
crooked portion;
FIG. 12 is a schematic longitudinal sectional view of the
endoscopic treatment instrument unit showing how the distal end of
the guide sheath including the crooked portion and the distal end
of the insertion portion of the endoscope including the crooked
portion are protruded relative to the distal end of the guide pipe
of the treatment instrument unit of the treatment system according
to the first embodiment, and how the distal end of the guide sheath
is aligned with the distal end of the insertion portion of the
endoscope, the crooked portion of the guide sheath is aligned with
the crooked portion of the insertion portion of the endoscope, and
the distal end of the guide sheath including the crooked portion
and the distal end of the insertion portion of the endoscope
including the crooked portion are turnable on the crooked portion
of the guide sheath;
FIG. 13 is a schematic longitudinal sectional view of the
endoscopic treatment instrument unit showing how the distal end of
the guide sheath including the crooked portion is protruded
relative to the distal end of the guide pipe of the treatment
instrument unit of the treatment system according to the first
embodiment, and how the insertion portion of the endoscope is
disposed on the most proximal side in the guide pipe, and the
distal end of the guide sheath including the crooked portion is
turnable on the crooked portion of the guide sheath;
FIG. 14 is a schematic longitudinal sectional view showing how the
distal end of the guide sheath including the crooked portion is
protruded relative to the distal end of the guide pipe of the
treatment instrument unit of the treatment system according to the
first embodiment, the distal end of the insertion portion of the
endoscope including the crooked portion is protruded relative to
the distal end of the guide sheath which is protruded relative to
the distal end of the guide pipe, and the distal end of the guide
pipe including the crooked portion and the distal end of the
insertion portion of the endoscope including the crooked portion
are turnable on their crooked portions;
FIG. 15 is a schematic longitudinal sectional view showing a guide
sheath of the treatment instrument unit of the treatment system
according to a modification of the first embodiment;
FIG. 16A is a schematic longitudinal sectional view showing a guide
pipe of the treatment instrument unit of the treatment system
according to a modification of the first embodiment;
FIG. 16B is a schematic enlarged view showing the distal end of the
bent pipe of the guide pipe indicated by the reference sign 16B in
FIG. 16A;
FIG. 17 is a schematic diagram of a treatment system according to a
second embodiment; and
FIG. 18 is a schematic longitudinal sectional view showing, in an
enlarged form, the endoscopic treatment instrument unit in the
vicinity of a connection pipe.
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of this invention will be described with
reference to the drawings.
The first embodiment is described with reference to FIG. 1A to FIG.
14.
As shown in FIG. 1A, a treatment system (endoscopic system) 10
according to this embodiment includes a treatment instrument unit
(endoscope insertion assist unit) 12, a controller 14, and a
monitor 16. The treatment instrument unit 12 includes an endoscope
18 and a treatment instrument (endoscopic insertion assist
instrument) 20.
A suction source 22 and a liquid supply source (liquid sending
source) 24 are connectable to the treatment instrument 20. A
change-over valve 28 such as a three-way cock is provided between
the end of a tube 26 extending from the treatment instrument 20,
the suction source 22, and the liquid supply source 24. Thus, a
user can selectively use the suction source 22 and the liquid
supply source 24 for the treatment instrument 20 by operating the
change-over valve 28. It is also preferable that an on-off valve 30
such as a three-way cock to which a syringe 32 can be removably
connected is provided for medication, for example, between the
change-over valve 28 and the liquid supply source 24. The
change-over valve 28 and the on-off valve 30 may be
electromagnetically operated by turning an unshown switch connected
to the controller 14 or may be manually switched.
A liquid supplied from the liquid supply source 24 can be suitably
selected. The liquid supply source 24 can supply a physiological
saline, for example, to clean an affected part in a paranasal sinus
inside a nose. Moreover, the liquid supply source 24 can supply a
chemical to treat the affected part. As the chemical, steroid or an
antibacterial agent is mainly administered. Here, instead of simply
administering the chemical, temperature-responding gel which
increases viscosity at about the body temperature may be used to
extend the time in which the chemical remains in the affected part.
In this case, if the chemical is administered to the affected part,
the viscosity of the chemical increases due to the body temperature
of a patient, so that the chemical does not easily flow out of the
affected part and remains for a longer time. That is, if such a
chemical is administered to the affected part, the chemical is
easily retained in the affected part. As the suction source 22, it
is possible to use, for example, a suction device provided on the
wall of an operation room as it is. For example, viscous matter
present in the paranasal sinus or around the affected part in a
nasal cavity can be removed by actuating the suction source 22.
When the affected part and the parts therearound are cleaned with
the physiological saline, this cleaning liquid can be removed
together with the viscous matter.
As shown in FIG. 2A and FIG. 2B, the endoscope 18 includes an
insertion portion 42, an antibreak 44, a support portion 46, and a
cable 48. The insertion portion 42 has a length of, for example,
about 200 mm, and is formed to protrude, for example, about 100 mm
relative to a distal end 104a of a later-described guide pipe 104.
The insertion portion 42 preferably has a small outside diameter
of, for example, about 1.0 mm to 2 mm. Thus, the endoscope 18 may
be any type such as a fiber type or an image pickup device type
such as a CCD or a CMOS, but a scanning type is preferably used. By
using such an endoscope 18, it is possible to have a small outside
diameter of the insertion portion 42 and obtain satisfactory image
quality.
The scanning endoscope 18 is known and is therefore not described
in detail. Meanwhile, the internal structure of a distal end 42a of
the insertion portion 42 is formed as shown in FIG. 3.
As shown in FIG. 3, the insertion portion 42 of the scanning
endoscope 18 includes a distal hard portion 52, a flexible pipe 54,
an illumination window 56, an actuator 58, an illumination fiber
60, and light receiving fibers 62. Among these components, the
illumination window 56, the actuator 58, the illumination fiber 60,
and the light receiving fibers 62 constitute an observation optical
system 64. That is, the observation optical system 64 is provided
inside the insertion portion 42. In the observation optical system
64, the actuator 58, the illumination fiber 60, and the light
receiving fibers 62 are optically and/or electrically connected to
the controller 14 shown in FIG. 1A.
The controller 14 shown in FIG. 1A controls the observation optical
system 64 of the endoscope 18. The controller 14 controls the
operation of the actuator 58. The controller 14 has an unshown
light source of, for example, white light, and properly causes
light for observation to enter the illumination fiber 60. The
controller 14 images the light received by the light receiving
fibers 62.
The distal hard portion 52, the illumination window 56, the
actuator 58, the distal end of the illumination fiber 60, and the
distal ends of the light receiving fibers 62 are provided at the
distal end 42a of the insertion portion 42.
The distal ends of the illumination window 56 and the light
receiving fibers 62 are fixed to a distal end face (distal end) 52a
of the distal hard portion 52. The distal ends of the light
receiving fibers 62 are fixed around the illumination window 56 at
proper intervals.
The distal hard portion 52 is provided with the actuator 58 on the
proximal side of the illumination window 56. The actuator 58
supports the distal end (a part closer to the proximal side than
the most distal end) of the illumination fiber 60. The actuator 58
is shaken by the controller 14, for example, in a spiral manner
shown in FIG. 4A and FIG. 4B. Thus, a distal end 60a of the
illumination fiber 60 is spirally shaken in accordance with the
operation of the actuator 58. Specifically, the controller 14
actuates the actuator 58, and moves illumination light emitted from
the distal end of the illumination fiber 60 from a position
indicated by a reference sign C in FIG. 4A to a position indicated
by a reference sign YMAX. The controller 14 also actuates the
actuator 58, and shakes the illumination light emitted from the
distal end of the illumination fiber 60 from the position indicated
by the reference sign YMAX in FIG. 4B to the position indicated by
the reference sign C as soon as the illumination light reaches the
position indicated by the reference sign YMAX. Therefore, the
surface of the subject is spirally scanned with the illumination
light through the distal end of the illumination fiber 60 and the
illumination window 56.
The light receiving fibers 62 receive reflected light from the
subject, and guide the light to the controller 14. The controller
14 shown in FIG. 1A images the light received by the light
receiving fibers 62, and displays the formed image on the monitor
16 connected to the controller 14.
As shown in FIG. 3, on the proximal side of the distal hard portion
52, the flexible pipe 54 extends to this proximal side. The length
of the distal hard portion 52 is, for example, about 10 mm. Thus,
the flexible pipe 54 accounts for the most of the total length of
the insertion portion 42. In other words, most of the insertion
portion 42 is formed as a flexible part. The antibreak 44 is fixed
to the proximal end of the flexible pipe 54. The support portion 46
is fixed to the proximal end of the antibreak 44. The cable 48 is
fixed to the proximal end of the support portion 46. The proximal
end of the cable 48 is connected to the controller 14.
The part of the insertion portion 42 of the endoscope 18 on the
proximal side of the actuator 58 is formed as a crooked portion
(first crooked portion) 66 provided with a shape having a bending
habit. That is, the distal end 42a of the insertion portion 42 of
the endoscope 18 includes a first area 43a on the distal side and a
second area 43b on the proximal side across the crooked portion 66.
An angle .alpha. of the first area 43a on the distal side to the
second area 43b on the proximal side is preferably about 20.degree.
to about 70.degree.. Between these angles, the angle .alpha. is
particularly preferably about 45.degree.. Due to the presence of
the crooked portion 66, the distal end 52a of the insertion portion
42 of the endoscope 18 moves to draw a circular-ring orbit in
response to the turning of the insertion portion 42 around a
central axis C. The scanning endoscope 18 then actuates the
actuator 58 to draw a spiral orbit. Thus, due to the rotation of
the insertion portion 42 around the central axis C, an observable
range of the subject can be wider than in a straight state (without
the crooked portion 66). The crooked portion 66 is formed at the
position of, for example, a distance (first distance) D1 from the
distal face (distal end) 52a of the distal hard portion 52 toward
the proximal side along the central axis C.
For example, the endoscope 18 has the upper side of the distal end
52a of the insertion portion 42 defined as an upward direction of
the monitor 16 and has the lower side of the distal end 52a of the
insertion portion 42 defined as a downward direction of the monitor
16. The left side and right side of the distal end 52a of the
insertion portion 42 and the leftward direction and rightward
direction of the monitor 16 are automatically defined when the
upper side and lower side of the distal end 52a of the insertion
portion 42 of the endoscope 18 and the upward direction and
downward direction of the monitor 16 are defined. Although set as
described above here, the upward and downward directions of the
monitor can be set in any manner depending on the handle unit and
the operator's preference.
As shown in FIG. 2A and FIG. 2B, the treatment instrument 20
includes a handle unit 102, the guide pipe 104, and a guide sheath
106. The handle unit 102 is grasped by the user and suitably
operated. In this endoscopic treatment system 10, the insertion
portion 42 of the endoscope 18, the guide sheath 106, and the guide
pipe 104 are arranged in order from the inside of the central axis
C to the outside.
The handle unit 102 includes a main body 112, guide rails 114, a
first operation element 116 which moves the guide sheath 106, and a
second operation element 118 which supports and moves the insertion
portion 42 of the endoscope 18.
As shown in FIG. 1A to FIG. 2B, the main body 112 defines a
longitudinal axis L by its distal end 112a and proximal end 112b.
As shown in FIG. 5A and FIG. 5B, the cross section of the main body
112 is substantially U-shaped. The upper side of the main body 112
is open. As shown in FIG. 2A and FIG. 2B, the guide rails 114 are
fixed to the distal end 112a and the proximal end 112b of the main
body 112, respectively.
The guide rail 114 is formed by a rod or a pipe which couples the
distal end 112a and the proximal end 112b of the main body 112
straight to each other. The guide rail 114 is made of a rigid
material such as stainless steel. One guide rail 114 is sufficient,
but two (a pair of) guide rails 114 are preferably formed parallel
to each other.
As shown in FIG. 2A, FIG. 2B, and FIG. 6A, a connection pipe 120 to
which the proximal end of the guide pipe 104 is coupled is fixed to
the distal end 112a of the main body 112. An O-ring 120a is
provided between the inner circumferential surface of the
connection pipe 120 and the outer circumferential surface of a
later-described inner pipe 156 of the guide sheath 106. The O-ring
120a exerts suitable frictional force between the inner
circumferential surface of the O-ring 120a and the outer
circumferential surface of the inner pipe 156 of the guide sheath
106. Thus, the guide sheath 106 can be turned around the central
axis C by the user operation and can be moved along the central
axis C, but is inhibited from free movement. The O-ring 120a is
prevented by a holding member 120b from coming off the proximal
side of the connection pipe 120.
As shown in FIG. 2A, FIG. 2B, FIG. 5A, FIG. 5B, FIG. 6A, and FIG.
6B, first and second holders 122 and 124 which move along the guide
rail 114 are provided between the distal end 112a and the proximal
end 112b of the main body 112. The first holder 122 is close to the
distal end 112a of the main body 112, and the second holder 124 is
close to the proximal end 112b of the main body 112. The first and
second holders 122 and 124 can come closer to and come in and out
of contact with each other along the guide rail 114.
As shown in FIG. 5A and FIG. 6B, a T-shaped pipe 132 which is in
communication with the space between the outer circumferential
surface of the insertion portion 42 of the endoscope 18 and the
inner circumferential surface of the guide sheath 106 is supported
on the first holder 122. A first rotor 134 rotatable around the
central axis C is provided at the distal end of the T-shaped pipe
132. The first holder 122, the T-shaped pipe 132, and the first
rotor 134 constitute the first operation element 116. The first
operation element 116 can move the guide sheath 106 in its axial
direction relative to the guide pipe 104 and the insertion portion
42 and can also turn the guide sheath 106 around its axis. That is,
the first operation element 116 can move the guide sheath 106
relative to the guide pipe 104 and the insertion portion 42.
A joint 136 which communicates with the central axis C of the
T-shaped pipe 132 and the first rotor 134 through a pipeline 132a
is connected to the T-shaped pipe 132. The joint 136 protrudes from
an opening 112c of the main body 112 of the handle unit 102. The
suction source 22, the liquid supply source 24, the change-over
valve 28, and the on-off valve 30 are connected to the joint 136 as
shown in FIG. 1A.
O-rings 138a and 138b are respectively disposed between the outer
circumferential surface of the distal end of the T-shaped pipe 132
and the first rotor 134 and between the inner circumferential
surface of the proximal end of the T-shaped pipe 132 and the outer
circumferential surface of the insertion portion 42 of the
endoscope 18. In particular, the O-ring 138b is prevented by a
holding member 140 from coming off the proximal side of the
T-shaped pipe 132. Thus, when a gas or a liquid is supplied from
the joint 136, the gas or the liquid can be guided toward the
distal side of the T-shaped pipe 132.
The O-ring 138b exerts suitable frictional force between its inner
circumferential surface and the outer circumferential surface of
the insertion portion 42 of the endoscope 18. Thus, the insertion
portion 42 of the endoscope 18 can be turned around the central
axis C by the user operation and can be moved along the central
axis C, but is inhibited from free movement. Here, the frictional
force between the inner circumferential surface of the O-ring 138b
and the outer circumferential surface of the insertion portion 42
of the endoscope 18 is set to such a degree that the second
operation element 118 does not unintentionally move in response to
the movement of the first operation element 116 and the movement of
the insertion portion 42.
The O-ring 138a exerts suitable frictional force between its outer
circumferential surface and the first rotor 134. Thus, the first
rotor 134 can be turned around the central axis C by the user
operation and can be moved along the central axis C, but is
inhibited from free movement.
Here, the guide sheath 106 shown in FIG. 7 has an inside diameter
which allows the insertion portion 42 to be inserted therethrough
so that the distal end 52a of the insertion portion 42 can protrude
relative to its distal end 106a, and the guide sheath 106 is
inserted through the guide pipe 104 so that its distal end 106a can
protrude relative to the distal end 104a of the guide pipe 104.
As shown in FIG. 7, the guide sheath 106 includes a sheath main
body 152, a sheath holder 154, and the inner pipe 156 from the
distal side to the proximal side.
The sheath main body 152 is formed into a tubular shape by an
elastically deformable resin material having a thickness of, for
example, about 0.1 mm. The sheath main body 152 is filled with a
meshed tube (not shown) called a braid. Thus, the sheath main body
152 according to this embodiment is sturdier than when simply made
of a resin material. That is, the sheath main body 152 of the guide
sheath 106 has a small thickness but has satisfactory rotation
following properties around the central axis C and is easily
bendable, and is unbreakably formed to ensure a hollow part
therein. The sheath main body 152 is preferably formed to be more
unbendable than the flexible pipe 54 of the insertion portion 42 of
the endoscope 18 shown in FIG. 3. Thus, when the whole distal hard
portion 52 of the insertion portion 42 and part of the flexible
pipe 54 protrude from the distal end 106a of the sheath main body
152, the position of the distal hard portion 52 can be held in a
desired state.
The sheath holder 154 shown in FIG. 6A and FIG. 7 is formed into a
cylindrical shape by a rigid material such as stainless steel. The
outer circumferential surface of the proximal end of the sheath
main body 152 is fixed to the inner circumferential surface of the
sheath holder 154 by, for example, bonding. The inner
circumferential surface of the distal end of the inner pipe 156
made of a rigid material such as stainless steel is fixed to the
outer circumferential surface of the sheath holder 154 by, for
example, bonding. The proximal end of the inner pipe 156 is fixed
to the inner circumferential surface of the first rotor 134 by, for
example, bonding. Thus, the inner pipe 156, the sheath holder 154,
and the sheath main body 152, that is, the guide sheath 106 move
together with the movement of the first operation element 116.
More specifically, if the first operation element 116 is moved
forward along the central axis C, the inner pipe 156, the sheath
holder 154, and the sheath main body 152, that is, the guide sheath
106 moves forward along the central axis C. If the first operation
element 116 is moved back along the central axis C, the inner pipe
156, the sheath holder 154, and the sheath main body 152, that is,
the guide sheath 106 moves back along the central axis C. If the
first operation element 116 is rotated or turned around the central
axis C, the inner pipe 156, the sheath holder 154, and the sheath
main body 152, that is, the guide sheath 106 rotate or turn around
the central axis C in the same direction as the rotation or turning
direction of the first operation element 116.
As shown in FIG. 7, a crooked portion 158 provided with a shape of
a bending habit is formed at a position of the sheath main body 152
of the guide sheath 106 located a distance (second distance) D2
from the distal end 106a of the sheath main body 152 toward the
proximal side. That is, a distal end 152a of the sheath main body
152 includes a first area 153a on the distal side and a second area
153b on the proximal side across the crooked portion (second
crooked portion) 158. An angle .beta. of the first area 153a on the
distal side to the second area 153b on the proximal side is, for
example, about 20.degree. to about 70.degree., and is preferably
about 45.degree.. Due to the presence of this crooked portion 158,
the distal end 106a of the guide sheath 106 moves to draw a
circular-ring orbit in response to the turning of the guide sheath
106 around the central axis C. Thus, the range in which the distal
end 106a of the sheath main body 152 can be directed to the
affected part (treatment target) can be wider than in a straight
state (without the crooked portion 158).
The distance D2 preferably corresponds to the distance D1 (see FIG.
3) from the distal end 52a of the distal hard portion 52 of the
crooked portion 66 formed in the insertion portion 42 of the
endoscope 18. That is, when the distal end 106a of the sheath main
body 152 of the guide sheath 106 corresponds to the distal end of
the insertion portion 42 of the endoscope 18 (the distal face 52a
of the distal hard portion 52), the crooked portions 66 and 158 are
located at the same position. The upper side and lower side of the
distal end 106a of the sheath main body 152 of the guide sheath 106
respectively correspond to the upper side and lower side of the
insertion portion 42 of the endoscope 18 shown in FIG. 3. Thus,
when the distal end 106a of the sheath main body 152 of the guide
sheath 106 corresponds to the distal end of the insertion portion
42 of the endoscope 18 (the distal face 52a of the distal hard
portion 52) and when the upper sides and lower sides correspond to
each other, the rotation following properties of the guide sheath
106 and the endoscope 18 in combination improve compared to the
rotation following properties obtained when the guide sheath 106
and the endoscope 18 are independent. As a result, operability
improves. However, the distance D1 and the distance D2 do not
always need to correspond to each other. For example, if the
distance D1> the distance D2, the distal end of the endoscope
having a small outer shape protrudes when the crooked portions 66
and 158 correspond to each other, and entry into a thin path is
easier. If the distance D2> the distance D1, the distal end of
the endoscope is located farther than the distal end 106a of the
guide sheath when the crooked portions 66 and 158 correspond to
each other, and a field of view is easily ensured even if the
device bumps into a tissue.
Each of the crooked portion (a shape of a bending tendency) 66
formed in the insertion portion 42 of the endoscope 18 and the
crooked portion (a shape of a bending tendency) 158 formed in the
guide sheath 106 is not exclusively disposed at one place.
As shown in FIG. 2A, FIG. 2B, and FIG. 5B, a second rotor 162
capable of rotating around the central axis C is provided in the
second holder 124. The second rotor 162 supports the support
portion 46 on the proximal side of the antibreak 44 of the
insertion portion 42 of the endoscope 18.
Here, the cross section of the support portion 46 of the endoscope
18 is substantially D-shaped. That is, the support portion 46 has a
plane 46a. The plane 46a of the support portion 46 is stopped from
rotating relative to the second rotor 162 by a pin 164. Thus, if
the second rotor 162 is turned around the central axis C, the
support portion 46, the antibreak 44, and the insertion portion 42
of the endoscope 18 turn around the central axis C. The second
holder 124 and the second rotor 162 form the second operation
element 118. The second operation element 118 can move the
insertion portion 42 in its axial direction relative to the guide
pipe 104 and the guide sheath 106 and can turn the insertion
portion 42 in its axial direction. That is, the second operation
element 118 can move the insertion portion 42 relative to the guide
pipe 104 and the guide sheath 106.
The guide pipe 104 can observe the distal side of the distal end
52a of the insertion portion 42 and the distal side of the distal
end 104a by the observation optical system 64 through the distal
end 104a. The guide pipe 104 allows the insertion portion 42 to be
inserted therethrough so that the distal side of the distal end 52a
of the insertion portion 42 can be observed by the observation
optical system 64 while allowing the distal end 52a of the
insertion portion 42 to protrude relative to the distal end
104a.
As shown in FIG. 8A, the guide pipe 104 has a bent pipe 172 and a
straight pipe 174 that are continuously formed. The guide pipe 104
has an inside diameter (e.g. about 1.5 to 3.0 mm) through which the
insertion portion 42 of the endoscope 18 and the sheath main body
152 of the guide sheath 106 can be inserted. The bent pipe 172 is
bent at an angle .gamma. of, for example, about 70.degree. to the
straight pipe 174. The guide pipe 104 shown in FIG. 8A is used to
treat, for example, the frontal sinus in the paranasal sinus.
Here, the inside diameter and bending radius R (e.g. about 5 to 25
mm) of the bent pipe 172 of the guide pipe 104 shown in FIG. 8A are
set in consideration of a length (rigid length) from the distal
face 52a of the distal hard portion 52 of the insertion portion 42
of the endoscope 18 to the proximal side along the central axis C
when the sheath main body 152 of the guide sheath 106 is disposed
on the outer circumference. Here, to perform an observation by the
endoscope 18, the guide pipe 104 has its inside diameter larger
than when a simple guide wire or light guide fiber is used.
Moreover, the inside diameter of the straight pipe 174 in
particular can be smaller than the inside diameter of the bent pipe
172, but is substantially the same inside diameter to more
effectively perform suction performance.
A distal end 172a of the guide pipe 104 is tapered. Thus, the
distal end 172a of the guide pipe 104 fits in the entrance of the
paranasal sinus, and owing to the size of the entrance, the distal
end 104a can be easily disposed on the far side from the near side
of the entrance (opening) of the paranasal sinus. The distal end
104a of the guide pipe 104 is formed to have an inside diameter
slightly larger than the outside diameter of the distal end 42a of
the insertion portion 42 of the endoscope 18 so that the distal end
42a of the insertion portion 42 of the endoscope 18 can pass
through the distal end 104a. This inside diameter is preferably is,
for example, about 1.5 to 3.0 mm.
Therefore, the straight pipe 174 of the guide pipe 104 allows the
guide sheath 106 to be moved while the insertion portion 42 is
inserted through the guide sheath 106. The bent pipe 172 of the
guide pipe 104 is located on the distal side of the straight pipe
174, and has an inside diameter and a bending radius that permit
the distal hard portion 52 of the insertion portion 42 to protrude
on the distal side through the distal end 104a of the guide pipe
104 while the insertion portion 42 is inserted through the guide
sheath 106.
The straight pipe 174 of the guide pipe 104 is made of a
combination of a rigid material such as stainless steel and a
flexible material such as a silicone material. That is, the
straight pipe 174 has a rigid portion 174a and an elastically
deformable elastic portion 174b shown in FIG. 8B. That is, at least
part of the straight pipe 174 is elastically deformable. Here, the
part of the straight pipe 174 from the proximal end of the rigid
portion 174a (the distal end of the elastic portion 174b) to the
distal end of the bent pipe 172 is seamlessly and integrally formed
by a stainless steel material. The elastic portion 174b may be
formed at any position between the distal end and proximal end of
the straight pipe 174. Owing to such an elastic portion 174b, if,
for example, the distal end 172a of the bent pipe 172 or the distal
end 104a abuts on a living tissue, the straight pipe 174 is
elastically deformed in the elastic portion 174b. Thus, it is
possible to prevent the guide pipe 104 from applying a load on the
living tissue.
Similar advantageous effects can be obtained even if the straight
pipe 174 is formed with suitable (given) flexibility as shown in
FIG. 8E. However, the straight pipe 174 of the guide pipe 104 is
preferably more high rigid than the guide sheath 106 and the
insertion portion 42 of the endoscope 18. Thus, it is possible to
guide the guide sheath 106 and the insertion portion 42 of the
endoscope 18 which are inserted through the guide pipe 104. It is
also preferable that in the guide pipe 104, not only the straight
pipe 174 but also the bent pipe 172 is formed to be more high rigid
than the guide sheath 106 and the insertion portion 42 of the
endoscope 18 and the guide pipe 104 is made of a resin material
which has suitable flexibility.
As shown in FIG. 6A, an adapter 175 is fixed to the proximal end of
the elastic portion 174b of the straight pipe 174 of the guide pipe
104. The adapter 175 is fixed to the connection pipe 120 by a fixed
element 175a such as a screw.
An O-ring 121a is provided between the connection pipe 120 and the
adapter 175 of the guide pipe 104. Thus, the space between the
guide pipe 104 and the adapter 175 is sealed. Therefore, the space
between the inner circumferential surface of the guide pipe 104 and
the adapter 175 can be airtight and/or liquidtight.
The distal end 104a of the guide pipe 104 shown in FIG. 8C is
formed into a rounded shape. Thus, applying a load on a mucous
membrane in the nose is prevented.
As shown in FIG. 8C, a balloon 176 which can be elastically
deformed into, for example, a ring shape is preferably disposed on
the outer circumferential surface of the distal end 172a of the
bent pipe 172. The balloon 176 is preferably inflated by air or a
liquid sent via the joint 136, the outside of the guide sheath 106,
and the inside or outside of the guide pipe 104. The balloon 176 is
used to cause the distal end 104a of the guide pipe 104 to abut on
and be supported on the vicinity of the entrance of the treatment
target from the inside or outside of the paranasal sinus in
accordance with the size of the opening of the paranasal sinus. The
balloon 176 can prevent the distal end 172a of the guide pipe 104
from easily put into the slightly larger entrance of the paranasal
sinus. The balloon 176 can be elastically deformed relative to the
slightly larger entrance of the paranasal sinus and then held in
the paranasal sinus, and prevent the distal end 104a of the guide
pipe 104 from easily coming off the entrance of the paranasal
sinus. It is possible to perform an observation or treatment in the
paranasal sinus with the stable endoscope 18. That is, by inflating
the balloon 176, the outer circumferential surface of the distal
end 172a of the guide pipe 104 can be held to the entrance of the
paranasal sinus around the opening of the paranasal sinus. Thus, by
inflating the balloon 176, it is possible to prevent the distal end
172a of the guide pipe 104 from being unstable and displaced
relative to the entrance of the paranasal sinus and then damaging
the tissue.
As shown in FIG. 8D, it is also preferable to use a flexible ring
178 such as a rubber material instead of the balloon 176. As the
balloon 176 shown in FIG. 8C, the ring 178 can be used to prevent
the distal end 172a of the guide pipe 104 from being easily put
into the slightly larger entrance of the paranasal sinus. The ring
178 can also be elastically deformed relative to the slightly
larger entrance of the paranasal sinus and then held therein, and
prevent the distal end 104a of the guide pipe 104 from coming off
the entrance of the paranasal sinus, and prevent the guide pipe 104
from overly entering the paranasal sinus so that the position of
the distal end 52a of the insertion portion 42 of the endoscope 18
may be unstable.
Here, for the simplification of explanation, the bending direction
of the bent pipe 172 relative to the straight pipe 174 in the guide
pipe 104 is defined on the upper side (see FIG. 1B) relative to the
main body 112 of the handle unit 102.
Although the bending direction of the bent pipe 172 relative to the
straight pipe 174 in the guide pipe 104 described in this
embodiment is upward (the opening direction of the main body 112 of
the handle unit 102), the bending direction can be set suitably to
the user's preference.
As shown in FIG. 9, a rotation direction index 182a is attached to
the outer circumferential surface of the first rotor 134 in the
first operation element 116. The rotation direction index 182a is
used to recognize the bending direction of the first area 153a
relative to the second area 153b, that is, the direction of the
distal end 106a of the guide sheath 106 resulting from the crooked
portion 158 of the sheath main body 152 of the guide sheath 106.
When the rotation direction index 182a is located immediately above
the main body 112 of the handle unit 102 as shows in FIG. 9, the
bending direction of the bent pipe 172 of the guide pipe 104
corresponds to the bending direction of the first area 153a of the
guide sheath 106.
The user can then recognize the direction of the distal end 106a of
the guide sheath 106 by recognizing the position of the index
182a.
A rotation direction index 182b is attached to the outer
circumferential surface of the second rotor 162 in the second
operation element 118. The rotation direction index 182b is used to
recognize the bending direction of the first area 43a relative to
the second area 43b, that is, the direction of the distal end 52a
of the insertion portion 42 resulting from the crooked portion 66
of the insertion portion 42 of the endoscope 18. When the rotation
direction index 182b is located immediately above the main body 112
of the handle unit 102 as shows in FIG. 9, the bending direction of
the bent pipe 172 of the guide pipe 104 corresponds to the bending
direction of the first area 43a at the distal end 42a of the
insertion portion 42 of the endoscope 18.
The user can then recognize the direction of the distal end 52a of
the insertion portion 42 by recognizing the position of the index
182b.
In FIG. 9, the rotation direction indexes 182a and 182b are drawn
as parallel segments having proper lengths parallel to the central
axis C and the longitudinal axis L. It will be appreciated that
instead of the segments, marks to be recognized by the user or
click sensations during operation may be used as the rotation
direction indexes 182a and 182b.
An annular index 184a that intersects at right angles with the
central axis C is attached to the outer circumferential surface of
the first rotor 134 in the first operation element 116. An annular
index 184b that intersects at right angles with the central axis C
is attached to the outer circumferential surface of the second
rotor 162 in the second operation element 118.
The annular indexes 184a and 184b in FIG. 9 do not always need to
be annularly attached, and it is also preferable that marks are
attached at proper intervals.
Axial direction indexes 186 which indicate a positional relation
between the first operation element 116 and the main body 112 and
also indicate a positional relation between the second operation
element 118 and the main body 112 are attached to a right edge 113a
and a left edge 113b of the main body 112 of the handle unit 102.
The axial direction indexes 186 are attached parallel to the
longitudinal axis L at regular intervals. The axial direction
indexes 186 have first and second main indexes 186a and 186b, and
subindexes 186c. Here, in FIG. 9, the first and second main indexes
186a and 186b are drawn thicker than the subindexes 186c. The first
main index 186a, the second main index 186b, and the subindexes
186c can be variously modified, for example, can be indicated in
different colors distinguishably from one another.
The first main index 186a is located adjacent to the annular index
184a of the first operation element 116 when the distal end 104a of
the guide pipe 104 corresponds to the distal end 106a of the guide
sheath 106. The second main index 186b is located adjacent to the
annular index 184b of the second operation element 118 when the
distal end 104a of the guide pipe 104 corresponds to the distal end
of the insertion portion 42 of the endoscope 18. Thus, the first
main index 186a defines a neutral position of the first operation
element 116, and the second main index 186b defines a neutral
position of the second operation element 118.
The subindexes 186c are attached at regular intervals not only
between the first and second main indexes 186a and 186b but also
from the first main index 186a to the distal end 112a of the main
body 112 of the handle unit 102 and from the second main index 186b
to the proximal end 112b of the main body 112 of the handle unit
102. The interval between the subindexes 186c can be suitably set,
for example, to 10 mm.
Therefore, when the first operation element 116 is moved relative
to the main body 112 of the handle unit 102, the user can easily
recognize the position of the distal end 106a of the guide sheath
106 relative to the distal end 104a of the guide pipe 104 and the
direction in which the distal end 106a is bent by the crooked
portion 158. When the second operation element 118 is moved
relative to the main body 112 of the handle unit 102, the user can
also easily recognize the position of the distal end 52a of the
insertion portion 42 of the endoscope 18 relative to the distal end
104a of the guide pipe 104 and the direction in which the distal
end 52a is bent by the crooked portion 66. Further, by recognizing
the positional relation between the first operation element 116 and
the second operation element 118, the user can easily recognize the
position of the distal end 52a of the insertion portion 42 of the
endoscope 18 relative to the distal end 106a of the guide sheath
106 and the direction in which the distal end 52a is bent by the
crooked portion 66.
Although the axial direction indexes 186 are attached to both of
the pair of edges 113a and 113b in the example described here, it
is also preferable that the axial direction indexes 186 are
attached to only one of the pair of edges 113a and 113b.
In has been explained here that the axial direction indexes 186 are
attached to the pair of edges 113a and 113b. Although not shown, it
is also preferable that the indexes 186 are attached to not only to
the edges 113a and 113b but also to the side surface of the main
body 112 of the handle unit 102 that continues to the edges 113a
and 113b.
It is also preferable that the indexes 182a, 182b, 184a, 184b, and
186 are formed to be visually recognizable and to be recognizable
when touched by the user.
It is preferable that an interlock mechanism (switch mechanism) 190
which maintains the positional relation between the first operation
element 116 and the second operation element 118 is disposed in the
handle unit 102. The interlock mechanism 190 can be brought into an
interlocked state to move the first operation element 116 and the
second operation element 118 together, and a non-interlocked state
to separately and independently move the first operation element
116 and the second operation element 118. Thus, the interlock
mechanism 190 functions as a switch unit which can switch to the
interlocked state and the non-interlocked state.
As an example of the interlock mechanism 190, a known wire type rim
brake can be disposed in the first rotor 134, for example, as shows
in FIG. 10. That is, the interlock mechanism 190 is provided in the
first rotor 134.
The interlock mechanism 190 includes a pair of movable bodies 192a
and 192b facing across the insertion portion 42, brake shoes 194a
and 194b provided in the movable bodies 192a and 192b, a traction
wire 196 having an interlocking body 196a coupled to the movable
bodies 192a and 192b, and a base 198 having a press pad 198a
coupled to the traction wire 196. The pair of movable bodies 192a
and 192b are turnably supported on the first rotor 134 by support
shafts 193a and 193b, respectively. The press pad 198a functions in
the same manner as a break lever. If the press pad 198a is pressed
against the base 198, the traction wire 196 is pulled. If the
traction wire 196 is pulled toward the press pad 198a, the movable
bodies 192a and 192b turn around the axes of the support shafts
193a and 193b, and then the brake shoes 194a and 194b come closer
to each other. Thus, the brake shoes 194a and 194b hold the outer
circumferential surface of the insertion portion 42. On the other
hand, if the press pad 198a is unpressed, the brake shoes 194a and
194b separate from each other and release the outer circumferential
surface of the insertion portion 42. Thus, the interlock mechanism
190 can actuate the first operation element 116 and the second
operation element 118 independently of or dependently on each
other.
Therefore, if, for example, the first operation element 116 is
moved forward along the central axis C in a situation in which the
interlock mechanism 190 is switched to the interlocked state (the
press pad 198a is in the pressed state), the interlock mechanism
190 interlocks to move the second operation element 118 the same
distance forward. If the first operation element 116 is moved back
along the central axis C, the interlock mechanism 190 interlocks to
move the second operation element 118 the same distance back.
Similarly, if, for example, the first operation element 116 is
turned around the central axis C in a situation in which the
interlock mechanism 190 is switched to the interlocked state, the
interlock mechanism 190 interlocks to turn the second operation
element 118 the same angle. When the second operation element 118
is operated, the first operation element 116 operates together. On
the other hand, in a situation in which the interlock mechanism 190
is switched to the noninterlocked state (the press pad 198a is in
the released state), the interlock mechanism 190 independently
operates the first operation element 116 and the second operation
element 118.
For example, if the interlock mechanism 190 is kept switched to the
interlocked state in a situation in which the first and second
operation elements 116 and 118 are disposed at the positions shown
in FIG. 9 relative to the main body 112 of the handle unit 102, the
distal end 52a of the insertion portion 42 and the distal end 106a
of the guide sheath 106 move together.
Next, the function of the treatment system 10 according to this
embodiment is described with reference to FIG. 11 to FIG. 14.
By properly moving the first and second operation elements 116 and
118, the user can properly observe the condition outside the
treatment instrument 20 while observing the distal end 104a of the
guide pipe 104 and the distal end 106a of the guide sheath 106 by
the observation optical system 64 of the insertion portion 42 of
the endoscope 18.
By properly moving the first and second operation elements 116 and
118, the user can cause the distal end 52a of the insertion portion
42 to be flush with or protrude from the distal end 104a of the
guide pipe 104 and the distal end 106a of the guide sheath 106. In
a situation in which the distal end 52a of the insertion portion 42
of the endoscope 18 is protruding out of the treatment instrument
20, the condition outside the treatment instrument 20 can be
properly observed by the observation optical system 64 of the
insertion portion 42 of the endoscope 18. In this case, blocking of
the field of views for the distal end 104a of the guide pipe 104
and the distal end 106a of the guide sheath 106 is prevented, so
that a wider range can be observed.
An example of treating, for example, the frontal sinus in the
paranasal sinus using the treatment system 10 is described below.
That is, a series of procedures using the treatment system 10 are
performed as below.
(Step 0) The treatment instrument unit 12 of the treatment system
10 is prepared as below.
The insertion portion 42 of the endoscope 18 is inserted through
the guide pipe 104 and the guide sheath 106 of the treatment
instrument unit 12 to form the treatment instrument unit 12.
As shown in FIG. 9, the annular index 184a of the first operation
element 116 is placed adjacent to the first main index 186a formed
on the edges 113a and 113b of the main body 112 of the handle unit
102. The annular index 184b of the second operation element 118 is
placed adjacent to the second main index 186b. In this instance,
the distal end 104a of the guide pipe 104, the distal end 106a of
the guide sheath 106, and the distal end 52a of the insertion
portion 42 of the endoscope 18 are at the same position. The
crooked portion 158 of the guide sheath 106 and the crooked portion
66 of the insertion portion 42 of the endoscope 18 are at the same
position.
The rotation direction index 182a of the first operation element
116 is disposed on the upper side of the main body 112 of the
handle unit 102. In this instance, the bending direction of the
bent pipe 172 relative to the straight pipe 174 of the guide pipe
104 corresponds to the bending direction of the first area 153a
relative to the second area 153b of the guide sheath 106. The
rotation direction index 182b of the second operation element 118
is disposed on the upper side of the handle unit 102. In this
instance, the bending direction of the bent pipe 172 relative to
the straight pipe 174 of the guide pipe 104 corresponds to the
bending direction of the first area 43a relative to the second area
43b of the insertion portion 42 of the endoscope 18. Further, the
bending direction of the first area 153a by the crooked portion 158
of the guide sheath 106 corresponds to the bending direction of the
first area 43a by the crooked portion 66 of the insertion portion
42 of the endoscope 18.
Thus, the first operation element 116 and the second operation
element 118 are disposed at neutral positions relative to the main
body 112 of the handle unit 102.
Owing to friction between the outer circumferential surface of the
guide sheath 106 and the O-ring 120a disposed in the connection
pipe 120 and friction between the O-ring 138a disposed in the first
operation element 116 and the first rotor 134, the first operation
element 116 is inhibited from unintentionally turning by, for
example, gravity and unintentionally moving along the central axis
C. Similarly, owing to friction between the outer circumferential
surface of the insertion portion 42 of the endoscope 18 and the
O-ring 138b disposed in the first operation element 116, the second
operation element 118 is inhibited from unintentionally turning by,
for example, gravity and unintentionally moving along the central
axis C. In this instance, frictional force between the inner
circumferential surface of the O-ring 138b and the outer
circumferential surface of the insertion portion 42 of the
endoscope 18 is set so to such a degree that the first operation
element 116 and the second operation element 118 independently
move.
The press pad 198a of the interlock mechanism 190 is released.
Thus, the first operation element 116 and the second operation
element 118 independently operate.
(Step 1) The distal end 104a of the guide pipe 104 and the distal
end 106a of the guide sheath 106 of the treatment instrument unit
12 of the treatment system 10, and the distal end 52a of the
insertion portion 42 of the endoscope 18 are inserted to the
entrance (opening) of the paranasal sinus which is a treatment
target from an external nostril.
The user (doctor) grasps the handle unit 102. The user guides the
distal end 104a of the guide pipe 104 of the treatment instrument
unit 12 to the entrance of the frontal sinus in the paranasal sinus
from, for example, the external nostril while maintaining the
condition described above in (Step 0).
In this instance, the user properly moves the handle unit 102 while
visually recognizing the monitor 16 which displays the images
observed by the endoscope 18. The user disposes the distal end 104a
of the guide pipe 104 in the vicinity of the entrance of the
frontal sinus in the paranasal sinus from the external nostril. A
middle nasal concha and a middle meatus are recognized on the
monitor 16. A semilunar hiatus is then recognized. The entrance of
the frontal sinus is then recognized above the semilunar
hiatus.
When the distal end 52a of the insertion portion 42 of the
endoscope 18 has come to a dead end, an observation image showing
the color of a mucous membrane is displayed on the entire monitor
16. On the other hand, when there is an insertion path ahead of the
distal end 52a of the insertion portion 42 of the endoscope 18, not
only the mucous membrane but also passage through a narrowed area
is displayed on the entire monitor 16.
A case in which there is an insertion path but the insertion path
is narrow is described as a first condition.
When the user is visually recognizing an observation image of the
endoscope 18 on the monitor 16, the user may recognize a narrow
insertion path. As shown in FIG. 11, the second operation element
118 is moved closer to the first operation element 116 from the
neutral position. The distal end 52a of the insertion portion 42 of
the endoscope 18 is protruded to the distal end 104a of the guide
pipe 104 and the distal end 106a of the guide sheath 106. In this
instance, the user can observe the distal side of the distal end
52a of the insertion portion 42 by the observation optical system
64 while the distal end 52a of the insertion portion 42 is
protruded to the distal end 104a of the guide pipe 104. The user
then moves the second operation element 118 while observing the
monitor 16 which displays the observation image of the endoscope
18. In this instance, the bending habit of the distal end 42a of
the insertion portion 42 resulting from the crooked portion 66 is
used to pass the distal end 52a of the insertion portion 42 through
the narrow path. After the distal end 52a of the insertion portion
42 has passed through the narrow path or as the distal end 52a of
the insertion portion 42 passes through the narrow path, the first
operation element 116 is moved toward the distal end 112a of the
main body 112 of the handle unit 102 as shown in FIG. 12. In this
instance, the first operation element 116 may be moved while the
second operation element 118 is being moved. The first operation
element 116 is moved away from the second operation element 118,
and the distal end 106a of the guide sheath 106 is moved closer to
the distal end 52a of the insertion portion 42. In this instance,
it is preferable that the circumferential positions and axial
positions of the distal end 52a of the insertion portion 42 and the
distal end 106a of the guide sheath 106 correspond to each
other.
The distal end 106a of the guide sheath 106 and the distal end 52a
of the insertion portion 42 are then inserted into the paranasal
sinus through the entrance of the paranasal sinus. The user then
properly moves the main body 112 while properly operating the first
operation element 116 relative to the main body 112 of the handle
unit 102. In this instance, the distal end 104a of the guide pipe
104 is moved along the insertion direction of the guide sheath 106
so that the condition in which the distal end 106a of the guide
sheath 106 is disposed inside the paranasal sinus is maintained.
Thus, the distal end 104a of the guide pipe 104 is disposed at the
entrance of the frontal sinus in the paranasal sinus.
A case in which the insertion path is sufficient to pass both the
distal end 52a of the insertion portion 42 and the distal end 106a
of the guide sheath 106 is described as a second condition.
When the insertion path is sufficient to pass both the distal end
52a of the insertion portion 42 and the distal end 106a of the
guide sheath 106, the guide sheath 106 and the insertion portion 42
of the endoscope 18 are protruded to the distal end 104a of the
guide pipe 104. In this case, it is preferable that the first
operation element 116 and the second operation element 118 are
operated while the press pad 198a of the interlock mechanism 190 is
pressed to interlock the first and second operation elements 116
and 118. That is, the first operation element 116 and the second
operation element 118 are moved toward the distal end 112a of the
main body 112 of the handle unit 102 so that the positional
relation between the first operation element 116 and the second
operation element 118 is maintained. In this instance, the user can
observe the distal side of the distal end 52a of the insertion
portion 42 by the observation optical system 64 while the distal
end 52a of the insertion portion 42 is substantially flush with the
distal end 104a of the guide pipe 104.
The distal end 106a of the guide sheath 106 and the distal end 52a
of the insertion portion 42 are then inserted into the paranasal
sinus through the entrance of the paranasal sinus. The user then
properly moves the main body 112 while properly operating the first
operation element 116 relative to the main body 112 of the handle
unit 102. In this instance, the distal end 104a of the guide pipe
104 is moved along the insertion direction of the guide sheath 106
so that the condition in which the distal end 106a of the guide
sheath 106 is disposed inside the paranasal sinus is maintained.
Thus, the distal end 104a of the guide pipe 104 is disposed at the
entrance of the frontal sinus in the paranasal sinus. The press pad
198a of the interlock mechanism 190 is then released.
A case in which viscous matter overly adheres to the insertion path
is described as a third condition.
When it is recognized from the observation image of the endoscope
18 that viscous matter overly adheres to the insertion path, the
distal end 106a of the guide sheath 106 is moved to the position
close to the viscous matter while the observation image is being
observed. That is, the first operation element 116 is moved toward
the distal end 112a of the main body 112 of the handle unit 102. In
this instance, the second operation element 118 is moved as
required so that the viscous matter can be observed by the
endoscope 18. In this instance, the user can observe the distal
side of the distal end 52a of the insertion portion 42 by the
observation optical system 64 through the distal end 106a of the
guide sheath 106. After the end of the observation, the second
operation element 118 is moved toward the proximal end 112b of the
main body 112 of the handle unit 102 as shown in FIG. 13 while the
position of the first operation element 116 is maintained. The
suction source 22 shown in FIG. 1 is then actuated to suck the
viscous matter from the distal end 106a of the guide sheath 106
through the space between the inner circumferential surface of the
guide sheath 106 and the outer circumferential surface of the
insertion portion 42. After the operation of the suction source 22
is stopped, the second operation element 118 is moved closer to the
first operation element 116 as shown in FIG. 12 to align the distal
end 52a of the insertion portion 42 with the distal end 106a of the
guide sheath 106.
When the suction of the viscous matter is difficult, the second
operation element 118 may be retreated to the proximal side, the
inner bore of the guide pipe 104 may be released, and suction may
be performed.
While the crooked portion 66 of the insertion portion 42 is
disposed in the range of the distal end 152a (e.g. the first area
153a) of the guide sheath 106, the first area 153a of the guide
sheath 106 will maintain its shape. That is, the first area 153a of
the guide sheath 106 resists the bending habit of the crooked
portion 66 of the insertion portion 42.
The insertion path is then confirmed, and the first and second
operation elements 116 and 118 are properly operated as in the
first condition and the second condition to insert the distal end
106a of the guide sheath 106 and the distal end 52a of the
insertion portion 42 into the paranasal sinus. The user then
properly moves the main body 112 while properly operating the first
operation element 116 relative to the main body 112 of the handle
unit 102. In this instance, the distal end 104a of the guide pipe
104 is moved along the insertion direction of the guide sheath 106
so that the condition in which the distal end 106a of the guide
sheath 106 is disposed inside the paranasal sinus is maintained.
Thus, the distal end 104a of the guide pipe 104 is disposed at the
entrance of the frontal sinus in the paranasal sinus.
A condition in which the crooked portion 158 of the guide sheath
106 and the crooked portion 66 of the insertion portion 42 of the
endoscope 18 are protruded relative to the distal end 104a of the
guide pipe 104 may be set as a neutral condition. In this instance
as well, the distal end 52a of the insertion portion 42 and the
distal end 106a of the guide sheath 106 are disposed in the
paranasal sinus as in the first to third conditions.
For example, when the distal end 104a of the guide pipe 104 of the
treatment instrument unit 12 is disposed in the opening of the
frontal sinus, there may be more than one entrance. In this case,
the distal end 104a of the guide pipe 104 of the treatment
instrument unit 12 is disposed at each entrance, the sinus on its
far side is observed by the endoscope 18, and whether the sinus is
the frontal sinus is judged. To select an insertion path, the
handle unit 102 can be moved to select an insertion path to insert
the guide sheath 106 and the distal end 52a of the insertion
portion 42 of the endoscope 18.
It is also possible to judge whether the distal end 52a of the
insertion portion 42 of the endoscope 18 can access a desired
paranasal sinus if the operation room is darkened and an
observation is performed and if the user visually recognizes, from
the outside of the body, illumination light of the endoscope 18
which transmits bone and skin.
A magnetic or optical navigation system may be used in addition to
this treatment system 10 to assist in selecting a path to insert
the guide pipe 104 and the insertion portion 42 of the endoscope 18
into the paranasal sinus.
The user can observe the path from the external nostril to the
entrance of the frontal sinus in detail by visually recognizing the
monitor 16. In this instance, the part which the distal end 104a of
the guide pipe 104 is facing is displayed on the monitor 16, so
that it is possible to find the entrance of the frontal sinus from
the semilunar hiatus and guide the distal end 104a of the guide
pipe 104 to the entrance of the frontal sinus by the endoscope 18
by properly moving the distal end 104a of the guide pipe 104.
In this instance, even if the insertion path from the external
nostril to the frontal sinus is unintentionally pressed by the bent
pipe 172 of the guide pipe 104, it is possible to prevent great
force from being applied to the insertion path owing to the elastic
deformation of the elastic portion 174b.
The user holds the handle unit 102 without moving the distal end
104a of the guide pipe 104 to maintain the positional relation
between the distal end 104a of the guide pipe 104 and the entrance
of the frontal sinus in the paranasal sinus. The user inflates the
balloon 176 (see FIG. 8C) disposed on the outer circumferential
surface of the distal end 172a of the guide pipe 104 to prevent
further insertion into the entrance of the frontal sinus in the
paranasal sinus. When the opening is larger than the outside
diameter of the guide pipe 104, the guide pipe 104 is put into the
entrance of the frontal sinus, the balloon 176 is inflated at the
place where a sufficient space can be secured, and the removal of
the guide pipe 104 from the frontal sinus is prevented.
In contrast, when the insertion path is narrow and the distal end
52a of the insertion portion 42 of the endoscope 18 can not pass
therethrough, the guide wire may move ahead or the path may be
extended by the balloon 176 to attempt the insertion into the
paranasal sinus.
Thus, the distal end 172a of the guide pipe 104 is disposed at the
entrance of the frontal sinus in the paranasal sinus, so that the
distal end 52a of the insertion portion 42 of the endoscope 18
and/or the distal end 106a of the guide sheath 106 can access the
inside of the paranasal sinus.
(Step 2) The observation image of the endoscope 18 is then used to
diagnose the inside of the paranasal sinus.
The distal end 172a of the guide pipe 104 is disposed at the
entrance of the frontal sinus in the paranasal sinus. As shown in
FIG. 2B, the distal end 106a of the guide sheath 106 and the distal
end 52a of the insertion portion 42 of the endoscope 18 are located
at the distal end 104a of the guide pipe 104. That is, the first
and second operation elements 116 and 118 are disposed at the
neutral positions. As shown in FIG. 12, the distal end 106a of the
guide sheath 106 and the distal end 52a of the insertion portion 42
of the endoscope 18 are protruded from the distal end 104a of the
guide pipe 104. In this instance, the distal end 106a of the guide
sheath 106 and the distal end 52a of the insertion portion 42 of
the endoscope 18 are located in the paranasal sinus.
In this condition, the second operation element 118 is moved to
move the distal end 52a of the insertion portion 42 of the
endoscope 18 to confirm the condition in the paranasal sinus, for
example, whether the viscous matter is retained, the condition of
the surface of the mucous membrane, the color and condition of
mucus, and the condition of the mucous membrane by observing the
monitor 16.
In this instance, as shown in FIG. 13 and FIG. 14, the second
operation element 118 is moved closer to the first operation
element 116, and the distal end 52a of the insertion portion 42 of
the endoscope 18 is protruded relative to the distal end 106a of
the guide sheath 106. The sheath main body 152 of the guide sheath
106 is more persevering and more unbendable than the insertion
portion 42 of the endoscope 18. Thus, when the crooked portion 66
of the insertion portion 42 of the endoscope 18 is located between
the distal end 106a of the guide sheath 106 and the crooked portion
158, the first area 153a of the guide sheath 106 maintains its
substantially straight state ignoring the presence of the crooked
portion 66 of the insertion portion 42 of the endoscope 18. On the
other hand, the insertion portion 42 of the endoscope 18 is bent
under the influence of the crooked portion 158 of the guide sheath
106. Thus, if the first operation element 116 and the second
operation element 118 are simultaneously turned in the same
direction around the central axis C, the distal end 52a of the
insertion portion 42 moves to draw a circular-arc orbit on the
crooked portion 158 of the guide sheath 106.
Even if the second operation element 118 alone is turned in a
direction around the central axis C in this case, the distal end
52a of the insertion portion 42 hardly moves its position.
Naturally, the image displayed on the monitor 16 turns.
The second operation element 118 is further moved closer to the
first operation element 116, and the crooked portion 66 of the
insertion portion 42 of the endoscope 18 is protruded relative to
the distal end 106a of the guide sheath 106. In this condition, the
second operation element 118 is turned around the central axis C.
Thus, the distal end 52a of the insertion portion 42 moves to draw
a circular-arc orbit on the crooked portion 66 of the insertion
portion 42 of the endoscope 18. If the first operation element 116
and the second operation element 118 are simultaneously turned in
the same direction around the central axis C, the distal end 52a of
the insertion portion 42 moves to draw a circular-arc orbit on the
crooked portion 158 of the guide sheath 106.
Naturally, while the crooked portion 158 of the guide sheath 106 is
retracted in the guide pipe 104, the crooked portion 66 of the
insertion portion 42 of the endoscope 18 may be protruded relative
to the distal end 104a of the guide pipe 104 so that the distal end
52a of the insertion portion 42 will move to draw a circular-arc
orbit on the crooked portion 66 of the insertion portion 42.
Thus, it is possible to adjust the position of the circular-arc
orbit of the distal end 52a of the insertion portion 42 of the
endoscope 18 by properly adjusting the positions of the distal end
106a of the guide sheath 106 and the crooked portion 158 relative
to the guide pipe 104 and the position of the distal end 52a of the
insertion portion 42 of the endoscope 18 relative to the distal end
106a of the guide sheath 106.
Therefore, the angle of the distal end 52a of the insertion portion
42 of the endoscope 18 to the central axis C can be changed in two
stages by the two crooked portions: the crooked portion 66 of the
insertion portion 42 and the crooked portion 158 of the guide
sheath 106. Thus, the distal end 52a of the insertion portion 42 of
the endoscope 18 can adjust the observation area from a narrow
range inside the paranasal sinus to a wide range.
The crooked portion 66 of the insertion portion 42 of the endoscope
18 is protruded relative to the distal end 106a of the guide sheath
106. Thus, while protruding from the distal end 104a of the guide
pipe 104, the distal end 52a of the insertion portion 42 of the
endoscope 18 is bent in the crooked portion 158 of the sheath main
body 152 of the guide sheath 106 and also bent in the crooked
portion 66 of the insertion portion 42.
The first operation element 116 and the second operation element
118 are then turned in the same direction around the central axis
C. That is, the press pad 198a of the interlock mechanism 190 is
pressed to operate the first operation element 116 or the second
operation element 118. In this instance, the distal end 52a of the
insertion portion 42 moves to draw a circular-arc orbit on the
crooked portion 158 of the guide sheath 106. The circular-arc orbit
in this case is larger in diameter than the circular-arc orbit
drawn on the crooked portion 66 of the insertion portion 42. Thus,
a wide range in the paranasal sinus can be observed by performing
this operation if necessary.
It is possible to adjust an observable range of the endoscope 18 by
properly adjusting the position of the distal end 52a of the
insertion portion 42 of the endoscope 18 relative to the distal end
106a of the guide sheath 106 and the position of the distal end
106a of the guide sheath 106 relative to the distal end 104a of the
guide pipe 104.
When there is viscous matter in the paranasal sinus, the user
confirms its color and amount on the monitor 16. When the viscous
matter is sucked and removed, the user moves the second operation
element 118 away from the first operation element 116 while
maintaining the distal end 106a of the guide sheath 106 in the
paranasal sinus as shown in FIG. 13. Thus, the distal end 52a of
the insertion portion 42 of the endoscope 18 is pulled out of the
guide pipe 104 through the distal end 106a of the guide sheath 106
and the distal end 104a of the guide pipe 104. In this instance,
the distal end 52a of the insertion portion 42 is disposed between
the pipeline 132a of the T-shaped pipe 132 and the O-ring 138b.
That is, the insertion portion 42 of the endoscope 18 is pulled out
of the guide sheath 106.
In this condition, the user actuates the suction source 22 to
perform suction. The viscous matter passes in the guide sheath 106
through the distal end 106a of the guide sheath 106, and is sucked
to the suction source 22 through the pipeline 132a of the T-shaped
pipe 132 of the first operation element 116. In this instance, if
the suction is possible even though the endoscope 18 remains inside
the guide sheath 106, the suction may be performed in this
situation without moving the second operation element 118.
After the suction source 22 is stopped, as shown in FIG. 14, the
second operation element 118 is moved closer to the first operation
element 116 to insert the distal end 52a of the insertion portion
42 of the endoscope 18 into the paranasal sinus beyond the distal
end 106a of the guide sheath 106. The colors and conditions of the
mucous membrane and the viscous matter in the paranasal sinus, and
the amount of the viscous matter are again confirmed are then again
confirmed on the monitor 16. In this instance, the first and second
operation elements 116 and 118 are properly moved back and forth,
and the first and second operation elements 116 and 118 are rotated
to confirm the inside of the paranasal sinus. In particular,
inflamed parts of the mucous membrane in the paranasal sinus are
confirmed.
Thus, the user observes the inside of the paranasal sinus using the
endoscope 18, and then diagnoses the state of the affected
part.
(Step 3) The inside of the paranasal sinus is cleaned if
necessary.
The user cleans the inside of the paranasal sinus if necessary.
A liquid such as a physiological saline is put into the paranasal
sinus from the liquid supply source 24. If a greater amount of the
supplied liquid is need, the distal end 52a of the insertion
portion 42 is pulled out of the guide pipe 104 through the distal
end 106a of the guide sheath 106 and the distal end 104a of the
guide pipe 104 while the distal end 106a of the guide sheath 106 is
maintained in the paranasal sinus, as shown in FIG. 13.
When the liquid is supplied from the liquid supply source 24 in
this condition, a greater amount of liquid can be supplied than
when the insertion portion 42 of the endoscope 18 is located inside
the guide sheath 106. If the first operation element 116 is then
turned, the range in which the liquid can be supplied by the
crooked portion 158 of the guide sheath 106 is apparently wider
than when the crooked portion 158 is not present. Thus, a wider
range can be cleaned if the treatment instrument unit 12 is
used.
After the inside of the paranasal sinus is cleaned with the
physiological saline (cleaning liquid) in this way, the
physiological saline containing the viscous matter is then sucked
by the suction source 22.
The second operation element 118 is then again moved closer to the
first operation element 116 to insert the distal end 52a of the
insertion portion 42 of the endoscope 18 into the paranasal sinus
beyond the distal end 106a of the guide sheath 106. The second
operation element 118 is then properly turned, and the first
operation element 116 is turned if necessary to confirm the color
and amount of the mucous membrane in the paranasal sinus on the
monitor 16.
When the viscous matter is remaining in the paranasal sinus, the
viscous matter is sucked. When there is viscous matter that can not
be sucked or when particular a mucous membrane tissue needs to be
extracted, the distal end 52a of the insertion portion 42 is pulled
out of the guide pipe 104 while the distal end 106a of the guide
sheath 106 is maintained in the paranasal sinus. The pin 164
disposed in the plane 46a of the support portion 46 of the
endoscope 18 is then removed to remove the insertion portion 42 of
the endoscope 18 from the treatment instrument 20. A forceps or a
brush, for example, is put through the guide sheath 106 from the
proximal side of the T-shaped pipe 132, and the distal end 106a of
the guide sheath 106 is inserted into the paranasal sinus beyond
the distal end 106a of the guide sheath 106. In this condition, the
mucous membrane tissue may be extracted by, for example, the
forceps or the brush. The forceps or the brush can also be used
instead of suction to collect the viscous matter.
(Step 4) The inside of the paranasal sinus is treated. For example,
medicine is administered to the affected part in the paranasal
sinus.
The forceps or the brush, for example, are removed from the
treatment instrument 20, and the insertion portion 42 of the
endoscope 18 is again attached to the treatment instrument 20.
The guide sheath 106 and the insertion portion 42 of the endoscope
18 are properly moved to confirm the affected part.
The chemical is stuck to the affected part from the liquid supply
source 24 through the space between the inner circumferential
surface of the guide sheath 106 and the outer circumferential
surface of the insertion portion 42.
In this instance, the chemical to be supplied is, for example,
steroid and/or an antibacterial agent. Moreover, the supplied
chemical is preferably retained in the paranasal sinus after the
supply. To supply the chemical, for example, a medicine such as
steroid and/or an antibacterial agent is contained in
temperature-responding gel which increases viscosity at about the
body temperature. Since the chemical increases viscosity after
supplied, the chemical can be in touch with the affected part for a
long time. The chemical is then retained in the paranasal sinus so
that the effect of the chemical can be longer. More simply, it is
also possible to produce a similar effect by inserting a piece of
fine gauze into the paranasal sinus and containing the chemical
therein or by putting a lid on the opening of the paranasal sinus.
It is also possible to blend the chemical with a biodegradable
material and gradually dissolving the chemical to keep the
effect.
The treatment instrument unit 12 according to this embodiment has
the two crooked portions 66 and 158. Thus, the range in which the
distal end 52a of the insertion portion 42 can be directed can be
wider than when the insertion portion 42 of the endoscope 18 alone
has the crooked portion. Therefore, it is possible to further
ensure that the affected part, that is, the inside of the paranasal
sinus can be observed and that the chemical can be administered or
sprayed to the affected part.
If necessary, the chemical is administered to the affected part
while the insertion portion 42 of the endoscope 18 is pulled out of
the guide sheath 106.
(Step 5) The treatment instrument unit 12 of the treatment system
10 is pulled out of the paranasal sinus.
The first and second operation elements 116 and 118 are moved
toward the proximal end 112b of the main body 112 of the handle
unit 102. Thus, the distal end 52a of the insertion portion 42 of
the endoscope 18 and the distal end 106a of the guide sheath 106
are pulled out of the paranasal sinus. The distal end 106a of the
guide sheath 106 and the distal end 52a of the insertion portion 42
of the endoscope 18 are then retracted relative to the distal end
104a of the guide pipe 104. When the balloon 176 is inflated, the
balloon 176 is deflated.
The guide pipe 104 is separated from the entrance of the paranasal
sinus and then pulled out of the nostril with the greatest possible
effort to prevent the distal end 104a of the bent pipe 172 of the
guide pipe 104 disposed at the entrance of the paranasal sinus from
abutting on the mucous membrane tissue inside the nose.
After the end of a series of treatments, the user pulls out the pin
164 disposed in the plane 46a of the support portion 46 of the
endoscope 18, and then removes the endoscope 18 from the treatment
instrument 20. The endoscope 18 is then cleaned, disinfected, and
sterilized to be reusable. On the other hand, the treatment
instrument 20 may be disassembled and then cleaned, disinfected,
and sterilized to be reusable or may be simply disposed of.
As described above, the following can be said according to the
treatment system 10 in this embodiment.
The treatment instrument unit 12 that combines the endoscope 18 and
the treatment instrument 20 is used to display the observation
image on the monitor 16, and the user can certainly dispose the
distal end 104a of the guide pipe 104, for example, at the entrance
of the paranasal sinus while viewing the observation image. In this
instance, the endoscope 18 is used, so that the user (doctor) can
easily recognize the situation in the insertion path (e.g. the
condition of the mucous membrane in the nose). Moreover, the
endoscope 18 is used, so that it is possible to safely and
certainly recognize whether a desired paranasal sinus is
accessed.
Therefore, by using the treatment instrument unit 12 according to
this embodiment, the distal end 104a of the guide pipe 104 can
safely and certainly access the entrance of the paranasal sinus
while directly recognizing the situation in the path from the
external nostril to the paranasal sinus by the observation
image.
The distal end 104a of the guide pipe 104 is made of a rigid
material such as stainless steel, and the elastic portion 174b is
provided in the straight pipe 174. Alternatively, the whole guide
pipe 104 is made of an elastic part having certain flexibility.
Therefore, even if excessive force is applied when the guide pipe
104 is in collision with the entrance of the paranasal sinus, the
elastic portion 174b bends so that it is possible to prevent any
load from being applied to the mucous membrane and bone around the
opening of the paranasal sinus.
In the treatment using the endoscopic treatment system 10 according
to this embodiment, the insertion portion 42 of the endoscope 18 is
flexible. Thus, when the distal end 52a of the insertion portion 42
of the endoscope 18 is introduced into the paranasal sinus, it is
not necessary to cut the entrance to the paranasal sinus, crush the
part around the entrance, or enlarge the entrance. According to
this embodiment, the balloon 176 provided at the distal end 172a of
the guide pipe 104 is inflated in the vicinity of the entrance of
the paranasal sinus. The guide pipe 104 only holds the position
relative to the entrance of the paranasal sinus. Therefore, when a
treatment using the treatment system 10 according to this
embodiment is conducted, it is possible to significantly reduce
invasion of the patient.
The treatment instrument unit 12 according to this embodiment
directly inserts the distal end 52a of the insertion portion 42 of
the endoscope 18 into the paranasal sinus through the distal end
104a of the guide pipe 104. Thus, the user can easily recognize the
situation in the paranasal sinus. Therefore, it is possible to
visually diagnose the condition of the inflammation of the mucous
membrane in the paranasal sinus.
The crooked portions 66 and 158 are formed in both the distal end
42a of the insertion portion 42 of the endoscope 18 and distal end
152a of the guide sheath 106. Thus, a wider range can be obtained
as the observation image on the endoscope 18 than when one of the
crooked portions is present. Thus, it is possible to inhibit the
movements of the guide sheath 106 and the insertion portion 42 of
the endoscope 18 along the central axis C to the minimum.
In particular, the crooked portion 158 is formed in the guide
sheath 106 which is more persevering and more unbendable than the
endoscope 18. Thus, the observation direction of the observation
optical system 64 of the insertion portion 42 can be faced in a
proper direction by the guide sheath 106. A narrowed part can be
observed by the endoscope 18 and simultaneously passed by the guide
sheath 106 while the positional relation between the insertion
portion 42 of the endoscope 18 and the guide sheath 106 is
maintained. Owing to the crooked portion 158 of the guide sheath
106, suction can be easily performed in a wide range, and water
supply (cleaning) and medication can be easily performed in a wide
range while the insertion portion 42 of the endoscope 18 is pulled
out of the guide sheath 106.
When the crooked portions 66 and 158 have the same shape and the
guide sheath 106 and the insertion portion 42 of the endoscope 18
overlap in the part of the same shape, the rigidity of the inserted
part in which the insertion portion 42 of the endoscope 18 is
adapted to the guide sheath 106 is higher than when each of these
components is a single component. Thus, the rotations of the guide
sheath 106 and the insertion portion 42 of the endoscope 18 around
the central axis C and their operability during insertion and
removal improve.
The indexes 182a, 182b, 184a, 184b, and 186 are properly formed in
the main body 112 of the handle unit 102 and the first and second
operation elements 116 and 118. Thus, by recognizing the positional
relation of the operation elements 116 and 118 to the main body 112
of the handle unit 102, the user can easily recognize the position
and pose (the direction brought to by the crooked portion 158) of
the distal end 106a of the guide sheath 106 and the position and
pose (the direction brought to by the crooked portion 66) of the
distal end 52a of the insertion portion 42 of the endoscope 18
relative to the distal end of the guide pipe 104.
Thus, the indexes 184a, 184b, and 186 of the handle unit 102 allow
the user to recognize the axial position of the distal end 106a of
the guide sheath relative to the distal end 104a of the guide pipe
104 and the circumferential position of the distal end 106a of the
guide sheath 106 relative to the distal end 104a of the guide pipe
104. The indexes 182a and 182b of the handle unit 102 allow the
user to recognize the axial position of the distal end 52a of the
insertion portion 42 relative to the distal end 104a of the guide
pipe 104 and the circumferential position of the distal end 52a of
the insertion portion 42 relative to the distal end 104a of the
guide pipe 104. In other words, the indexes 182a and 184a of the
first operation element 116 allow the user to recognize the axial
position of the distal end 106a of the guide sheath 106 relative to
the distal end 104a of the guide pipe 104 and the circumferential
position of the distal end 106a of the guide sheath 106 relative to
the distal end 104a of the guide pipe 104. The indexes 182b and
184b of the second operation element 118 allow the user to
recognize the axial position of the distal end 52a of the insertion
portion 42 relative to the distal end 104a of the guide pipe 104
and the circumferential position of the distal end 52a of the
insertion portion 42 relative to the distal end 104a of the guide
pipe 104. The user can then recognize that the bending directions
of the crooked portions 66 and 158 correspond to each other when
the first index 182a of the first operation element 116 and the
second index 182b of the second operation element 118 are at the
same circumferential position. Moreover, the user can recognize
that the crooked portions 66 and 158 correspond to each other when
the index 184a of the first operation element 116 and the index
184b of the second operation element 118 are respectively located
at predetermined axial positions (positions located at a distance)
relative to the main body 112 of the handle unit 102.
The interlock mechanism 190 can be properly used to switch between
the interlocked state and the non-interlocked state. Therefore, in
the interlocked state, one of the first and second operation
elements 116 and 118 can only be operated to move the guide sheath
106 and the insertion portion 42 of the endoscope 18 in the same
direction. Thus, it is possible to reduce the number of times of
operations in which the user alternately moves the two operation
elements 116 and 118 little by little.
The endoscopic treatment instrument 20 according to this embodiment
is used together with the endoscope 18 including the insertion
portion 42 which is flexible and through which the observation
optical system 64 is inserted. The treatment instrument 20 includes
the guide pipe 104 which has the first distal end 104a and through
which the insertion portion 42 is inserted so that the distal end
52a of the insertion portion 42 and the distal side of the first
distal end 104a are observable through the first distal end 104a by
the observation optical system 64 or so that the distal side of the
distal end 52a of the insertion portion 42 is observable by the
observation optical system 64 while the distal end 52a of the
insertion portion 42 is protruded relative to the first distal end
104a, and the guide sheath 106 which has the second distal end 106a
and which has an inside diameter to insert the insertion portion 42
therethrough so that the distal end 52a of the insertion portion 42
is configured to protrude relative to the second distal end 106a
and which is inserted through the guide pipe 104 so that the second
distal end 106a is configured to protrude relative to the first
distal end 104a of the guide pipe 104. Thus, by using the treatment
instrument 20 according to this embodiment together with the
endoscope 18, it is possible to safely and certainly cause the
distal end 104a of the guide pipe 104 to access the entrance of the
paranasal sinus while recognizing the situation in the path from
the external nostril to the paranasal sinus by the observation
image. Moreover, by using the treatment instrument 20 together with
the endoscope 18, it is possible to directly observe the symptom of
each part in the paranasal sinus and conduct a treatment.
As shown in FIG. 15, a balloon 159 may be disposed on the outer
circumferential surface of the first area 153a of the sheath main
body 152 of the guide sheath 106. For example, when a patient has a
narrow path in the opening of the paranasal sinus, the path can be
expanded by this balloon as needed to insert the insertion portion
42 of the endoscope 18. The balloon 159 is expanded at a pressure
of about 8 to 12 atmosphere by a liquid or a gas through a
separately provided balloon expanding lumen.
The shape of the bent pipe 172 of the guide pipe 104 according to
this embodiment can be changed suitably to the treatment target. As
shown in FIG. 16A, the angle .gamma. of the bent pipe 172 to the
straight pipe 174 of the guide pipe 104 is, for example, about
110.degree.. This angle .gamma. is greater than the angle .gamma.
of the bent pipe 172 to the straight pipe 174 of the guide pipe 104
shown in FIG. 8A. The guide pipe 104 shown in FIG. 16A is
preferably used to treat, for example, the maxillary sinus of the
paranasal sinus. The inside diameter and bending radius R (e.g.
about 5 to 25 mm) of the bent pipe 172 of the guide pipe 104 are
set in consideration of the length (rigid length) from the distal
end 52a of the distal hard portion 52 of the insertion portion 42
of the endoscope 18 to the proximal side along the central axis C
when the sheath main body 152 of the guide sheath 106 is disposed
on the outer circumference. Here, to perform an observation by the
endoscope 18, the guide pipe 104 has its inside diameter larger
than when a simple guide wire or light guide fiber is used.
Moreover, the inside diameter of the straight pipe 174 in
particular can be smaller than the inside diameter of the bent pipe
172, but is substantially the same inside diameter to more
effectively perform suction performance.
The paranasal sinus which is the treatment target for the treatment
instrument unit 12 of the treatment system (endoscopic system) 10
according to this embodiment is not limited to the frontal sinus or
the maxillary sinus.
The straight pipe 174 of the guide pipe 104 shown in FIG. 16A is
also made of a combination of a rigid material such as a metal
(e.g. stainless steel or aluminum alloy material) or a rigid resin
(e.g. polyethylene (PE) or polypropylene (PP)) and a flexible
material such as silicone or a nylon material, similarly to the
guide pipe 104 shown in FIG. 8A. The straight pipe 174 has the
distal rigid portion 174a, the elastic portion 174b, and a proximal
rigid portion 174c. Here, the part of the straight pipe 174 from
the proximal end of the rigid portion 174a (the distal end of the
elastic portion 174b) to the distal end of the bent pipe 172 is
seamlessly formed. The elastic portion 174b may be formed at any
position between the distal end and proximal end of the straight
pipe 174. Owing to such an elastic portion 174b, if, for example,
the bent pipe 172 abuts on a living tissue, the straight pipe 174
is elastically deformed in the elastic portion 174b. Both the
sheath main body 152 of the guide sheath 106 disposed inside the
guide pipe 104 and the flexible pipe 54 of the insertion portion 42
of the endoscope 18 are flexible. Thus, it is possible to prevent
any load from being applied to the living tissue by the guide pipe
104.
The adapter 175 is fixed to the guide pipe 104 shown in FIG. 16A on
the outer circumferential surface of the proximal end of the
proximal rigid portion 174c. The balloon 176 may be formed as a
circumferential projection made of a material such as rubber.
As shown in FIG. 16B, the balloon 176 which functions in a manner
similar to the balloon 176 shown in FIG. 8C is preferably
provided.
Next, the second embodiment is described with reference to FIG. 17
and FIG. 18. This embodiment is a modification of the first
embodiment, and the same components as the components described in
the first embodiment or components having the same functions are
provided with the same signs as much as possible, and are not
described here.
As shown in FIG. 17 and FIG. 18, the treatment instrument 20
according to this embodiment has two joints 136a and 136b. As shown
in FIG. 17, a change-over valve 28a and the suction source 22 are
connected to the first joint 136a in order. A change-over valve 28b
and the liquid supply source 24 are connected to the second joint
136b in order.
The change-over valve 28a, for example, a three-way cock is
provided between the end of a tube 26a extending from the first
joint 136a of the treatment instrument 20 and the suction source
22. A syringe 32a, for example, can be connected to the change-over
valve 28a. The change-over valve 28b, for example, a three-way cock
is provided between the end of a tube 26b extending from the second
joint 136b of the treatment instrument 20 and the liquid supply
source 24. A syringe 32b, for example, can be connected to the
change-over valve 28b. The change-over valves 28a and 28b may be
electromagnetically operated by turning an unshown switch connected
to the controller 14 or may be manually switched.
As shown in FIG. 18, the joint 136a which communicates with the
central axis C of the connection pipe 120 through a pipeline 121 is
connected to the connection pipe 120. The joint 136a protrudes
downward from the main body 112 of the handle unit 102. The first
joint 136a is in communication with the space between the inner
circumferential surface of the guide pipe 104 and the outer
circumferential surface of the guide sheath 106. The first joint
136a is connected to the suction source 22, and is mainly used to
suck a tissue such as viscous matter.
The adapter 175 is fixed to the proximal end of the proximal rigid
portion 174c of the straight pipe 174 of the guide pipe 104. The
adapter 175 is fixed to the connection pipe 120 by, for example,
the fixed element 175a.
The O-ring 121a is provided between the connection pipe 120 and the
adapter 175 of the guide pipe 104. Thus, the space between the
guide pipe 104 and the adapter 175 is sealed. Therefore, owing to
the O-rings 120a and 121a, an object to be sucked is sucked through
the pipeline 121 and the joint 136a as a result of the suction by
the suction source 22.
The second joint 136b shown in FIG. 17 is formed in the same manner
as the joint 136 described in the first embodiment. That is, the
second joint 136b is in communication with the space between the
outer circumferential surface of the insertion portion 42 of the
endoscope 18 and the inner circumferential surface of the guide
sheath 106. The second joint 136b is connected to the liquid supply
source 24, and is mainly used to supply a liquid, for example, for
cleaning with the physiological saline.
Suction and liquid supply can be simultaneously performed by use of
the treatment system 10 according to second embodiment. Thus, it is
not necessary to switch between suction and liquid supply during a
treatment, and the treatment time can be reduced.
Other structures and functions are similar to those described in
the first embodiment, and are not described here.
Additional advantages and modifications will readily occur to those
skilled in the art. Therefore, the invention in its broader aspects
is not limited to the specific details and representative
embodiments shown and described herein. Accordingly, various
modifications may be made without departing from the spirit or
scope of the general inventive concept as defined by the appended
claims and their equivalents.
* * * * *